Unnecessary referrals for glaucoma could be avoided by use of 'gold
standard' device

2 Nov 2010

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The use of a 'gold standard' device by community
optometrists when measuring internal eye pressure can cut needless
referrals for suspected glaucoma, indicates preliminary research
published online in the British Journal of Ophthalmology.

Since the publication of new guidance from the UK's National
Institute for Health and Clinical Excellence (NICE), new referrals
for suspected glaucoma have increased substantially. When checked by
specialists at the hospital some of these referrals are found to be
unnecessary. The sharp rise is putting a strain on hospital eye
services, increasing costs to hospitals, and causing unnecessary
distress for patients, say the authors.

If a more precise, but inevitably more expensive, piece of
equipment was used to test for glaucoma the community optometrists
would make less inappropriate referrals.

The researchers assessed how many referrals for suspected
glaucoma (internal (intraocular) fluid eye pressure of over 21)
could be avoided if the Goldmann applanation tonometer (GAT) were
used for all patients.

High intraocular pressure is a key sign of glaucoma, and is
measured by the amount of pressure needed to flatten the surface of
the eye (cornea).

NICE recommends GAT, but other options are frequently used
instead by community optometrists, because they are cheaper and
don’t require the use of anaesthetic eye drops.

Over a period of five months, people with intraocular pressures
of between 22 and 25, measured with other tonometers, and with no
other symptoms of glaucoma, were assessed again using GAT.

Out of 3,295 people assessed at four community optometry services
during this time, 73 (2.2%) had a high intraocular pressure. They
would normally have been referred to the hospital eye service for
further tests.

But when the assessment was repeated using GAT, almost two thirds
of this group (46) had intraocular pressures of 21 or below and so
did not need to be referred.

“The use of Goldmann applanation tonometry by optometrists, prior
to instigating a referral to the [hospital eye service] has huge
potential to reduce unnecessary referrals,” conclude the authors.